Organization
PEORIA NON- EMERGENCY MEDICAL TRANSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORY E. WALLACE (OWNER/OPERATOR)
(309) 857-1165
Entity
Organization
Contact information
Practice address
3624 W CASSADAGA CT, PEORIA, IL 61615-3952
(309) 857-1165
Mailing address
3624 W CASSADAGA CT, PEORIA, IL 61615-3952
(309) 857-1165
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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